LATEST PEDIATRIC UROLOGY CERTIFICATION
EXAM OFFERED BY AMERICAN BOARD OF
UROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A newborn male has a left nonpalpable testis and a
right descended testis. Ultrasound shows the left
testis is intra-abdominal. Which is the most
appropriate next step?
A) Laparoscopic orchiopexy at 6-12 months
B) Observation; spontaneous descent may occur
C) Hormonal therapy (hCG)
D) Orchiectomy
Correct answer: A
Rationale: Intra-abdominal testis requires surgical
orchiopexy (laparoscopic or open) between 6-12
months to preserve fertility and reduce malignancy
risk.
2. A 2-year-old boy presents with a history of
recurrent febrile urinary tract infections (UTIs). Renal
bladder ultrasound shows left hydronephrosis (SFU
grade 3) and a dilated ureter. Voiding
cystourethrogram (VCUG) shows left vesicoureteral
,reflux (VUR) grade IV. Which is the most appropriate
next step?
A) Observation with antibiotic prophylaxis
B) Endoscopic injection (Deflux)
C) Ureteral reimplantation
D) Annual ultrasound only
Correct answer: C
Rationale: Grade IV VUR with breakthrough
infections despite prophylaxis is an indication for
surgical reimplantation.
3. A 6-week-old male presents with vomiting and
failure to thrive. Electrolytes show hyponatremia,
hyperkalemia, and metabolic acidosis. Genital exam
shows penoscrotal hypospadias with bilateral
nonpalpable gonads. Which is the most likely
diagnosis?
A) Congenital adrenal hyperplasia (CAH) due to 21-
hydroxylase deficiency
B) Androgen insensitivity syndrome
C) Mixed gonadal dysgenesis
D) Partial androgen insensitivity
Correct answer: A
,Rationale: Salt-wasting CAH (21-hydroxylase
deficiency) presents with adrenal crisis and
ambiguous genitalia in males (hyperpigmented
scrotum).
4. A 4-year-old girl presents with a palpable
abdominal mass. Ultrasound shows a right renal
mass with calcifications. Urinalysis shows hematuria.
Which is the most appropriate next step?
A) CT chest/abdomen/pelvis and surgical resection
(nephrectomy)
B) MRI abdomen
C) Needle biopsy
D) Chemotherapy before surgery
Correct answer: A
Rationale: Wilms tumor (nephroblastoma) presents
as an abdominal mass; initial imaging (CT) and
surgical resection without prior biopsy (unless
bilateral or uncertain) is standard.
5. A newborn male has a left hydronephrosis on
prenatal ultrasound. Postnatal ultrasound shows SFU
grade 3 hydronephrosis with a dilated ureter
(ureterocele seen within the bladder). Which is the
most likely diagnosis?
, A) Ureterocele with duplex collecting system
B) Primary obstructed megaureter
C) Posterior urethral valves (PUV)
D) Ureteropelvic junction (UPJ) obstruction
Correct answer: A
Rationale: Ureterocele (cystic dilation of intravesical
ureter) is associated with duplex system and upper
pole obstruction.
6. A 3-month-old male with a history of prenatally
diagnosed hydronephrosis has a normal renal
bladder ultrasound. Which is the most appropriate
next step?
A) Repeat ultrasound at 6 months
B) Voiding cystourethrogram (VCUG)
C) Diuretic renogram (MAG3)
D) No further imaging
Correct answer: D
Rationale: Prenatal hydronephrosis with normal
postnatal ultrasound resolves spontaneously; no
further imaging is needed.
EXAM OFFERED BY AMERICAN BOARD OF
UROLOGY | COMPLETE EXAM Q&A WITH
RATIONALES
1. A newborn male has a left nonpalpable testis and a
right descended testis. Ultrasound shows the left
testis is intra-abdominal. Which is the most
appropriate next step?
A) Laparoscopic orchiopexy at 6-12 months
B) Observation; spontaneous descent may occur
C) Hormonal therapy (hCG)
D) Orchiectomy
Correct answer: A
Rationale: Intra-abdominal testis requires surgical
orchiopexy (laparoscopic or open) between 6-12
months to preserve fertility and reduce malignancy
risk.
2. A 2-year-old boy presents with a history of
recurrent febrile urinary tract infections (UTIs). Renal
bladder ultrasound shows left hydronephrosis (SFU
grade 3) and a dilated ureter. Voiding
cystourethrogram (VCUG) shows left vesicoureteral
,reflux (VUR) grade IV. Which is the most appropriate
next step?
A) Observation with antibiotic prophylaxis
B) Endoscopic injection (Deflux)
C) Ureteral reimplantation
D) Annual ultrasound only
Correct answer: C
Rationale: Grade IV VUR with breakthrough
infections despite prophylaxis is an indication for
surgical reimplantation.
3. A 6-week-old male presents with vomiting and
failure to thrive. Electrolytes show hyponatremia,
hyperkalemia, and metabolic acidosis. Genital exam
shows penoscrotal hypospadias with bilateral
nonpalpable gonads. Which is the most likely
diagnosis?
A) Congenital adrenal hyperplasia (CAH) due to 21-
hydroxylase deficiency
B) Androgen insensitivity syndrome
C) Mixed gonadal dysgenesis
D) Partial androgen insensitivity
Correct answer: A
,Rationale: Salt-wasting CAH (21-hydroxylase
deficiency) presents with adrenal crisis and
ambiguous genitalia in males (hyperpigmented
scrotum).
4. A 4-year-old girl presents with a palpable
abdominal mass. Ultrasound shows a right renal
mass with calcifications. Urinalysis shows hematuria.
Which is the most appropriate next step?
A) CT chest/abdomen/pelvis and surgical resection
(nephrectomy)
B) MRI abdomen
C) Needle biopsy
D) Chemotherapy before surgery
Correct answer: A
Rationale: Wilms tumor (nephroblastoma) presents
as an abdominal mass; initial imaging (CT) and
surgical resection without prior biopsy (unless
bilateral or uncertain) is standard.
5. A newborn male has a left hydronephrosis on
prenatal ultrasound. Postnatal ultrasound shows SFU
grade 3 hydronephrosis with a dilated ureter
(ureterocele seen within the bladder). Which is the
most likely diagnosis?
, A) Ureterocele with duplex collecting system
B) Primary obstructed megaureter
C) Posterior urethral valves (PUV)
D) Ureteropelvic junction (UPJ) obstruction
Correct answer: A
Rationale: Ureterocele (cystic dilation of intravesical
ureter) is associated with duplex system and upper
pole obstruction.
6. A 3-month-old male with a history of prenatally
diagnosed hydronephrosis has a normal renal
bladder ultrasound. Which is the most appropriate
next step?
A) Repeat ultrasound at 6 months
B) Voiding cystourethrogram (VCUG)
C) Diuretic renogram (MAG3)
D) No further imaging
Correct answer: D
Rationale: Prenatal hydronephrosis with normal
postnatal ultrasound resolves spontaneously; no
further imaging is needed.
